Provider Demographics
NPI:1629280458
Name:PRESSEL, GLENN A (MFT)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:A
Last Name:PRESSEL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 492298
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-2298
Mailing Address - Country:US
Mailing Address - Phone:808-987-6078
Mailing Address - Fax:
Practice Address - Street 1:260 KAMEHAMEHA AVE
Practice Address - Street 2:215
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2859
Practice Address - Country:US
Practice Address - Phone:808-987-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist